REGULATORS, WAKE UP!

"The IPCC have declared a climate
change code red for humanity."


INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

	Science Based Targets initiative (SBTi)
	"Corporate climate action has potential, but it's currently voluntary... and failing."

"The very people giving the seal of approval
to business climate climate action - like the
Science Based Targets initiative (SBTi) -
are allowing companies to write their own
questionable rules, without checking whether
those rules are even being followed."

My source:

FTWeekend, 24-25 September 2022, p.11. 

See also:

Take aim, fire! @StandMighty @amazonwatch @IENearth in @FT on @sciencetargets conflicts of interest with the members they aren't regulating. @topnigel pic.twitter.com/QiwdBaaJzw

— Chris Brown (@chrisigloo) September 24, 2022

Do you have the intell? ... [Sure?]

PERSON

|

INTERPERSONAL : SCIENCES

humanistic ----------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

GROUP - COMMUNITY - POPULATION

emotional intelligence	physical intelligence
Social & Cultural Intelligence	Political Intelligence? [What the State provides ...]

My reminder: Book Reviews, "Physical Intelligence", What Investment, October 2020, p.51.

If you have 'reflective literacy' what is its scope?

h2cm: fixed or primary concepts the push and pull of nursing

When commentators, students and others write of the primary or core concepts of nursing what does this mean in terms of Hodges' model [h2cm]?

For quite some time I have been describing Hodges' model as a cognitive - conceptual space. This suggests that there are fixed concepts within the care domains. Yes, they may vary according to the context and over time, but if concepts were arrows and our aim is true then h2cm would provide the ideal target. It on this care matrix that we really could take aim and nail the kernels of knowledge that make up our care activities.

Is it a mistake to venture that for people to talk of basic nursing care, essential care needs, that there must be some fixed ideal out there; an ideal that nurses, society and policy makers can hang discussion and debate upon? And let's face it there is much to debate - mental health stigma, obesity, nutritionism, heart disease, dementia, unplanned pregnancies, funding, access, poverty. ...

Medical sociology has done and continues to do society at large a great service. It forces practitioners to look over their shoulder and take in the social and cultural forces that influence health. As a question for further deliberation within medical / clinical sociology we might ask: How are the concepts in Hodges' model fixed? There are several possible answers:

1. Someone determines that concepts a, b, c, d are in care domains 1, 2, 3, 4. The question of whether Hodges' model (or any other conceptual resource) is classed as evidence based depends on how that determination is made.

2. Alternately, the structure of the model provided by the axes, could act as a skeleton. This might serve as a boot strap breathing life into the empty spaces created by this structure. The first instances of concepts might then arise like some sort of quantum event - self, other, temperature, time, height, mood. ...

3. As (medical) sociology, philosophy and psychology continue to reveal, we also need to accept of course that society, culture and language are all inextricably linked and they pre-empt that empty space, predetermining what will be written (thought and reflected) there.

4. This external influence is a must if those working in the health and social care professions are to communicate with those 'outside' (public involvement can only run so far?). It is not so much a case of common ground, as common space and the freedom and opposition that this affords. this is essential for communication amid what is variously called - multidisciplinary working and integrated care. Here there must be a degree of latitude between different disciplines' usages of terms. This must provide common understanding or some close approximation and yet still be safe.

So rather than empty space the care domains are really full of care concepts all waiting on tenterhooks, to see whether they will get to aggrandise and become 'complex care needs'. Will the assessor / care evaluator pick them - from what is initially a virtual crowd? Go on make their day: care-fully!

20/20 vision minus 1, 2, or 4 blind spots....

Basic science classes very quickly introduce students to 'the eye' and vision.

This includes the simple experiment that can be done which reveals the blind spot.

Here's an example from (what was) Service Works Consulting:

Consulting companies pride themselves on knowledge, foresight and expertise. This is fine if there is only one blind spot to deal with, but of course we each have two. From the perspective of project management there are many more blind spots.

Hodges' model suggests there are potentially four;
five even if we include the spiritual domain.

A benefit of using Hodges' model* is that just as in normal vision our two eyes overlap and compensate for the blind spots; so attention paid to just one additional care domain may diminish the impact of care domain blindness.


3 out of 4 domains - is better (more holistic) than - 2 out of 4.

The problem in health and social care, is that any one of four blind spots (ironically the site of the optic nerve bundle) can become a fuse for trouble or disaster.

If you have the gift of vision - best to use it.^#
*cognitively or deliberately on paper or computer

Image source with many thanks: John Eric Hughes

Additional links:
Visual acuity: http://en.wikipedia.org/wiki/Visual_acuity

^#Wish I had and could do that!

Holistic Care: Squaring the Wheel of Disciplinary Domains

Over the past two years on W2tQ, I've defined h2cm in several ways, covering the model's axes and care domains, houses and sailing....

In January (2008) a dialogue was posted with Barbara Rylko-Bauer who shared some very helpful thoughts and suggestions on the model's name and the incorporation of culture and economics into the title of the respective SOCIOLOGY and POLITICAL care domains.

Thinking around this and my still limited (frustrated) reading of Michel Serres' and others I realised that the axes can be replaced with hyphens. This subtraction results in an interesting addition to the model's structure, perceived and potential content (domains).

Around the time the links page content were justified (or not) I also posted about the INTERPERSONAL domain and how this domain is more accurately described as the INTRAPERSONAL. That particular point was about a domain, but Barbara's point invited much more. Four hyphens certainly don't deliver, but the focus here has shifted:

the scope is not 90° but 180°

The hyphen forces contemplation of two domains and the axis in-between. See what you think:

Although hardly novel to geographers and those of a political bent 'PHYSIO-POLITICAL' is perhaps the most unfamiliar of these terms to people in health and social care - outside of public (mental) health - about which more to follow. ...

Where the heck am I (and where are you on Hodges' model)?

A combination of nursing experience and informatics knowledge and skills have meant that for a long time I have been able to sit on the fence and listen appreciatively to two sides of an ongoing saga. I am sure the ending will be a happy one, if not for the reason that there is no such thing as a 'finished' (nursing) information system. There is however a need for targets, deadlines, plans for a series of software releases and all the activities that accompany 'IT' projects. In short - project management. There is then a constant need for people to sit on the fence.

While the ability to sit on the fence may be something of an advantageous position, there are times when it becomes a source of anxiety and dissonance. Off the fence as a nurse without an informatics role (without i-portfolio), you feel left out of things. Literally chomping at the bit to contribute to the developments taking place - elsewhere.

Also off the fence, but alternately wearing the informatics shoes you have a sense that those soft, fuzzy caring, psychobabble skills are slowly yet inexorably melting away. How credible can you be if you have not 'nursed', that is - seen a client, managed your case load for 1, 2 or 3 years? Whatever your field, you can lose your touch.

Reading Michel Serres and his use of Harlequin as a trope really caught my imagination and breath (as lots of things do). Here's some background to Harlequin (and Hermes):

Two figures, then, inform Serres's oeuvre: Hermes and the Harlequin. Hermes the traveller and the medium allows for the movement in and between diverse regions of social life. The Harlequin is a multicolored clown standing in the place of the chaos of life. Two regions of particular interest to the voyager in knowledge are those of the natural sciences and the humanities. Should science really be opened up to poetry and art, or is this simply an idiosyncrasy on Serres's part? Is this his gimmick? The answer is that Serres firmly believes that the very viability and vitality of science depends on the degree to which it is open to its poetical other. Science only moves on if it receives an infusion of something out of the blue, something unpredictable and miraculous. The poetic impulse is the life-blood of natural science, not its nemesis. Poetry is the way of the voyager open to the unexpected and always prepared to make unexpected links between places and things. The form that these links take is of course influenced by technological developments; information technology transforms the senses, for example. Source: Dr.Vicente Forés López

This short quote hopefully illustrates the attraction of Serres to me as I study Hodges' model and informatics. Discovering Serres really creased me up. I say creased because that is where I am, trapped between two worlds. Stuck in that line between HUMANISTIC and MECHANISTIC realms. If I run the gauntlet there, the only other avenue open to me is that afforded by the INDIVIDUAL and GROUP axis.

Now I'm clearly not the only one able to sit on the fence and take in the views and perspectives of two frequently disparate worlds. On informatics secondment and at events such as HC2008 (HC2009) as a nurse - informatician (?) you have to see lost opportunities looking at the speaker line-up and number of nurses present and enabled to take the messages home.

As a fact of life change will happen.

How much better though is change borne of
dialogue and engagement?

Like Harlequin those of us with clinical AND informatics insights must mix things up. There is a need to constantly enquire, challenge, influence and direct at times. A need also to pass the baton and let others experience the dual perspectives from the fence (and the splinters too).
Image sources: http://commons.wikimedia.org/wiki/User:Malene
and http://www.qosmiq.com/cdiadrone/ghis/pfolio/characters/index.htm
 

Upon common ground: programming languages, therapies and care models ('space')

Perhaps programming languages, psychological interventions and models of care are closer than we think?

"It is worth remembering that a new programming language is sometimes viewed as a panacea, especially by its adherents. But no one language will supplant all the others; no one tool is unarguably the best for every task. There are many different problem domains in the world and many possible constraints on problems within those domains."

Fulton, Hal (2007) The Ruby Way (2nd Ed.), Chapter 1: Ruby in Review, Addison-Wesley, p.1

Fulton includes some great quotes - this from the Introduction:

The way that can be named is not the true Way.

- Lao Tse, Tao Te Ching

Lao Tse also wrote on 'space'.

Four knowledge domains = four audiences?

I don't know if there is any sense in this, but people look for 'signs' all the time - don't we? With the last front-end revision of the website (early 2005) I had twigged that there are at least four audiences that an introduction to Hodges' model needs to address.

Looking at the care domains the following seemed to fall just right:

Patients and Carers : Students - Lifelong Learners

Public [Citizens] : Policy makers, Managers

These may be lost to many visitors (but not you!) given the surfing attention span. If people do access and digest the first page above, which acts as a general introduction, they may not reach the second audience specific page.

Should I swap these around?

What is provided on the first page of each, is a basic h2cm graphic showing some relevant concepts for that particular domain. (It's this representation that trivialises h2cm).

The introductions do need revising and updating. I found some typos on the student - sciences piece, so not the best effort.

I think overall though this approach works - and highlights the need for collaboration and engagement on so many levels.

What do you think, any suggestions?

Ecotherapy to follow...

Holistic Bandwidth: All or Nothing

Quite a few years ago (Jones, 2004), I took the term bandwidth from the information and communication technology (ICT) world and applied it to health and social care. We seem to have been trying to achieve holistic and integrated care for decades. When care assessment, planning, intervention and evaluation is limited in scope this creates a narrowing of perspective, a bottleneck. Just as bandwidth problems used to affect the quality of on-line experience, so the bandwidth in health and social services ultimately affects the quality of care.

There's nothing wrong with perspective.

It's essential to making sense of the world. And after all, that railway line travels all the way to the vanishing point and it doesn't stop there. Road or railway - there's enough space reading between the lines to launch a whole film and literary genre.

I've said it before – but it really is ironic that many of the constraints in ICT have been overcome through broadband, memory costs/capacity and multi-core processors; while health services still struggle, still need to change:

From DISEASE - TREATMENT to PREVENTION - ENABLING ...

Single-track thinking is no longer sufficient, even if it is reassuring being able to see where you came from.

There’s an interesting non-trivial aside that follows from this bandwidth notion. The old conundrum of quality versus quantity.

Quality and quantity are the ties that bind, the Gordian knot. Cut this one at your peril!

Failure to focus on priorities, to take in that single, that utmost life-threatening perspective could result in disaster. Intensive care is the obvious example. Failure to attend to the physical priorities because of what seem new-age, airy-fairy ideas will quickly get you noticed.

There’s probably a paper out there on quality, quantity and appeals to holistic care. Returning to bandwidth I have wondered about how to measure this? Integrated care pathways and variance might be one approach, serious incident reports may be another revelatory approach? If it’s a care concept and moves ((uses energy) has currency) measure it!

There are a raft of measures for all sorts of things including, mood, behaviour, nursing care related, quality, risk and dependency. If you know of any that might measure holistic bandwidth, please let me know and add a comment here.

In the meantime I’ll ramble on - travelling h2cm's tracks…


Jones, P. (2004). Viewpoint: Can Informatics And Holistic Multidisciplinary Care Be Harmonised? British Journal of Healthcare Computing & Information Management, 21, 6, 17-18.

Gordian knot image c/o Bernice Steinbaum Gallery.

What is a 'domain'?

With visitors to the website confusing the title Hodges' Health Career Model for job careers; the addition of 'Care Domains' was intended to reduce confusion.

I think this has helped, but because the future beckons and this blog plus the website appear to have a multidisciplinary readership more clarity may be of help, especially the use of this word 'domain'.

The dictionary is a good place to start:

do·main

1. A territory over which rule or control is exercised.
2. A sphere of activity, concern, or function; a field: the domain of history. See synonyms at field.
3. Physics. Any of numerous contiguous regions in a ferromagnetic material in which the direction of spontaneous magnetization is uniform and different from that in neighboring regions.
4. Law.
a) The land of one with paramount title and absolute ownership.
b) Public domain.
5. Mathematics.
a) The set of all possible values of an independent variable of a function.
b) An open connected set that contains at least one point.
6. Biology. Any of three primary divisions of living systems, consisting of the eukaryotes, bacteria, and archaea, that rank above a kingdom in taxonomic systems that are based on similarities of DNA sequences.
7. Computer Science. A group of networked computers that share a common communications address.
[Source: Answers.com]

1. A territory over which rule or control is exercised: can apply in Hodges' model from a theoretic perspective by a curriculum, a scheme of work, and consequently in practice. We refer to the clinical domain, medical domain or social domain. This latter usage overlaps with 2. we often speak of fields of study and practice.

Place (territory) is the vital ingredient here; specific wards, clinics, treatment centres and even community may be described as a domain of care. The way 'domain' is used in day-to-day language may vary markedly. On some occasions the domain in question may be at an even higher level: clinical domain versus management domain.

3. Is interesting because although they are not exactly magnetic, there are several polarities* at work in Hodges' model.

On the borders between Hodges' domains, what is the 'switch' (context, situation, person focus ...) that determines the placement and direction of care concepts: for example - humanistic or mechanistic?

Sticking with physics there are undoubtedly several chaotic attractors within the bounds of Hodges' model. From the behaviour of the heart to the role of psychosocial stress in risk of relapse. If several variables are linked chaotically, what risks are run if one or more domains (however defined) are deemed non-relevant or out of scope?

4. This legalistic definition of 'domain' also applies. Hodges' model is person-centred, but although focused on the individual the model acknowledges the need to reconcile the diametric opposition that is the law that prevails for the one [INTERPERSONAL] and the law, justice and systems of the many [SOCIAL] and [POLITICAL].

Hodges' model is also in the public 'domain' all that is needed is an acknowledgement.

The remaining definitions 5, 6 and 7 - maths, biology and computer science - are all connected.

The connection?

Language?

More to follow.... Hope to return over the weekend...
*Will post about polarities, when I take a certain photo over in Manchester.
Just hope they don't pull it down before I get there! Bye for now...